Uterine closure with unlocked suture in cesarean section: Safety and Quality

Abstract

Objective: Comparing locked and unlocked uterine closure techniques in terms of bleeding control and uterine incision healing. Methods: The patients undergoing cesarean section in Sifa University Hospital between May - October 2012 were accepted to this prospective controlled study. Primarily, safety was evaluated. The hemoglobin count (HC) and serum creatine kinase (CK) levels of the patients in the locked (n = 47) and unlocked (n = 35) groups were measured just before and 24 hours after operation. Hemoglobin deficit, increase in CK and the additional hemostatic sutures were compared. Secondly, uterine scar healing was evaluated three months later. Scar thickness, niche and percentage of thinning of the scar region of the locked (n = 27) and unlocked (n = 32) groups were calculated and compared. Results: The hemoglobin deficit was similar in two groups. CK rise was less in the unlocked group but it was not significant (P = 0.082). Unlocked group needed more additional sutures (P = 0.016). The thickness of the niche and the percentage of thinning of the scar region were significantly less in the unlocked group (P= 0.002, P=0.000). Conclusions: Unlocked uterine closure technique is safe and has less damage to the myometrium.

Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta‐analysis

“…Our results are in line with the results of these reviews concerning short-term outcomes 13,14 or RMT 13,15 when single-and double-layer uterine closure were compared. We were able to include five additional studies [21][22][23]31,34 for single-versus double-layer closure reporting on scar healing, and five studies 22,23,26,30,39 for locked versus unlocked suturing. We were able to include five additional studies [21][22][23]31,34 for single-versus double-layer closure reporting on scar healing, and five studies 22,23,26,30,39 for locked versus unlocked suturing.…”

“…A P-value <0.05 was considered statistically significant. Three of four cohort studies [26][27][28] were considered to have a high risk of bias for 'blinding of outcome assessment', as they did not report on blinding. Ultimately, we included 20 studies (15 053 women) in our meta-analysis.…”

“…Figure S1 shows the reviewing process of potentially eligible articles. Two studies 26,29 were scored as high risk of bias for 'other bias', as they performed no correction for confounders. One study (n = 50) 21 evaluated our primary outcome without any of our secondary outcomes, resulting in 15 003 included women for secondary outcome evaluation.…”

“…As we used the same tool for randomised and non-randomised trials, with the first two items (randomisation and allocation concealment) consequently scored as high risk of bias for the four cohort studies, we looked at the remaining five items to determine overall risk of bias. Three of four cohort studies [26][27][28] were considered to have a high risk of bias for 'blinding of outcome assessment', as they did not report on blinding. Two studies 26,29 were scored as high risk of bias for 'other bias', as they performed no correction for confounders.…”

Reply: Niche risk factor for uterine rupture?

“…We did not consider inclusion of the meta-analysis 6 that demonstrated that the locked modification of the single-layer technique increases the risk of uterine rupture, as we included only publications evaluating risk factors for a niche and not those for uterine rupture. However, it was recently reported that the depth of a niche was lower following the unlocked closure technique in comparison with the locked closure technique 7 .…”